| NPI | 1760425102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 129153-1) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA MD023559E) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NJ 25MA05519500) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2013-09-26 |